Medicine - Haematology

Question 1

What tests should you order when querying IDA in a sick vs healthy patient?

Answer 1

No illness: Ferritin

Illness: TIBC, TF, iron

Why? Ferritin is an acute phase protein

Question 2

What markers will be raised in iron deficiency anaemia?

Answer 2

LDH, haptoglobins, uBR

Question 3

Differentiate the class of immunoglobulin associated with warm vs cold AIHA?

Answer 3

Warm: IgG

Cold: IgM

Question 4

How is warm AIHA managed?

Answer 4

Steroids, splenectomy

Question 5

Recall some causes of warm AIHA

Answer 5

Lymphoma
CLL
Drug allergy
SLE

Question 6

Recall some causes of cold AIHA

Answer 6

Myclopasma pneumoniae
EBV
CMV

Question 7

What abnormality would be seen on blood film in warm AIHA?

Answer 7

Spherocytes

Question 8

What test is used to identify paroxysmal nocturnal haemoglobinuria?

Answer 8

Ham’s test

Question 9

If warm AIHA and hereditory spherocytosis both have spherocytes, what test can be used to differentiate them?

Answer 9

Coomb’s/DAT test
Positive in AIHA
Neg in HS

Question 10

Recall 3 possible causes of MAHA

Answer 10

HUS
TTP
Adenocarcinoma

Question 11

Recall 3 electrolyte abnormalities seen in tumour lysis syndrome

Answer 11

Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia

Question 12

How should tumour lysis syndrome be managed?

Answer 12

Allopurinol
IV if high risk
PO if low risk

Question 13

What Hb level indicates packed RBC transfusion?

Answer 13

No ACS: <70g/L

ACS: <80g/L

Question 14

Recall 4 contraindications for platelet transfusion

Answer 14

Chronic BM failure
Heparin-induced thrombocytopaenia
ITP
TTP

Question 15

Which inherited thrombophilia increases the relative risk of DVT the most?

Answer 15

Antithrombin III deficiency

Question 16

What is the prevalence of Factor V Leiden?

Answer 16

5%

Question 17

What is the most common inherited bleeding disorder?

Answer 17

Von Willebrand

Question 18

What is the aetiology (broadly) of heparin-induced thrombocytopaenia?

Answer 18

Antibodies form against heparin and platelet factor 4 –> platelet activation via various mechanisms –> PROTHROMBOTIC state (even though it’s a thrombocytopaenia)

Question 19

Which blood group antigens are most likely to cause a delayed transfusion reaction?

Answer 19

Duffy

Kidd

Question 20

What % of the population are Rh pos?

Answer 20

85%

Question 21

What sort of transfusion reaction does Rhesus incompatability cause?

Answer 21

Delayed haemolytic

Question 22

Recall the storage conditions for RBCs, platelets and FFP

Answer 22

RBCs: 4C for 35 days
Platelets: 22C for 7 days
FFP: frozen

Question 23

How long does FFP need to thaw?

Answer 23

20-30 mins

Question 24

How long can RBCs be out of the fridge?

Answer 24

4 hours

Question 25

Most of the heritable haem disease information

Answer 25

is in the path decks

Question 26

Recall the parameters of each class of blood loss (depending on % volume lost)

Answer 26

Type 1: 0-15% lost, HR <100, BP normal, cap refill normal Type 2: 15-30% lost, tachycardic, BP normal, cap refil >2s Type 3: 30-40% lost, + tachycardic, BP reduced, cap refil >2s Type 4: >40% lost, ++ tachycardic, BP reduced, cap refil undetectable, anuric

Question 27

What investigation is required to confirm the diagnosis of ITP?

Answer 27

Blood film

Question 28

What is the risk of replacing folate without B12 in a patient who is both B12 and folate deficient?

Answer 28

Subacute combined degeneration of the cord

Question 29

What are the 4 key electrolyte derangements in tumour lysis syndrome?

Answer 29

Hyperkalaemia, hyperuricaemia, hyperphosphataemia, | Hypocalcaemia

Question 30

How should tumour lysis syndrome be managed?

Answer 30

Rasburicase (allopurinol = prophylaxis)

Question 31

What sort of cancer does pernicious anaemia predispose to?

Answer 31

Gastric carcinoma

Question 32

What is the mechanism of action of dabigatran?

Answer 32

Dirent thrombin inhibitor

Question 33

What does irradiation do to red cells?

Answer 33

Reduces the number of T lymphocytes to reduce the risk of GvHD in people who've received lots of blood transfusions

Question 34

What are the 2 main constituents of cryoprecipitate?

Answer 34

Factor VIII and fibrinogen

Question 35

What is the first line treatment of ITP?

Answer 35

Oral prednisolone

Question 36

Main signs of Chronic Myeloid leukaemia

Answer 36

splenomegaly increased granulocytes thrombocytosis | treat with Imatinib

Question 37

Tranmission of what type of infection for platelet transfusion

Answer 37

Bacteria - room temperature

Question 38

Features of blood product transfusion complications

Answer 38

Non - haemolytic febrile - fever, chills - stop transfusion and give paracetamol Minor allergic reaction - pruritus - temporailiy stop, give anti-histamine Anaphylaxis - obvious (IgA def can cause) Acute haemolytic - ABO incompatible - fever with hypotension - stop, confrim patient, coombs test, cross match - fluid resus - RBC destroyed by IgM antibodies TACO - pulmonary oedema and hypertension, fast transfusion - stop - IV loop diuretic TRALI - Non cardiogenic PO, hypotension, pulmonary infilitraes on Xray - stop and give oxygen

Question 39

What is post-thrombotic syndrome and how is it treated?

Answer 39

venous obstruction and insufficiency as a result of chronic venous hypertension - pain, pruritus, swelling, varicose and ulceration Compression stockings once developed

Question 40

Everything for Hodgkin's lymphoma

Answer 40

Reed-sternberg - eosinophilic nucleoli (owls eye) RF: HIV / EBV Features: Lymphadenpathy, alcohol lymph node pain, B symptoms Ix: normocytic anaemia, eosinophilia, LDH up and biopsy

Question 41

Features and treatment for anti-phospholipid syndrome

Answer 41

think recurrent miscarriage etc low dose aspirin + LMWH once a fetal heart sound seen

Question 42

Main causes of massive splenomegaly

Answer 42

Myelofibrosis CML Visceral leishmaniasis malaria gauchers syndrome

Question 43

Features of G6PD

Answer 43

Neonatal jaundice heinz - bite and blister cells check levels 3 months after hemolysis

Question 44

What drugs can trigger haemolysis in g6pd deficiency?

Answer 44

Anti-malarials - primaquine ciprofloxacin sulph - e.g. phonamides

Question 45

why are irrdiated blood products given?

Answer 45

Avoid transfusion - associated graft versus host disease by destroying T cells

Question 46

Features of neutropenic sepsis

Answer 46

complication of cancer therapy (7-14 days after) 0.5> neutrophils high temperautre staph epidermis most common fluoroquinolone prophylaxis ABs immediately - tazocin if febrile after 48 hrs - vancomycin

Question 47

Combination of high reticulocyte count and severe anaemia indicate

Answer 47

Sickle cell anaemia

Question 48

What are the sickle cell crises?

Answer 48

Thrombotic - infection, dehydration, deoxygenation, clinical, infarct other organs Acute chest syndrome - pulmonary vasculature, dyspnoea, chest pain, pulmonary infilitrates lowpO2 - pain relief Aplastic - infection parvovirus, sudden hb fall, bone marrow supression = low reticulocyte count Sequestration crises = pooling of blood, increased reticulotcyte count

Question 49

Investigation results for VWD

Answer 49

prolonged bleeding time APTT prolonged | tranexamic acid / desmopression treatment

Question 50

Features of Beta=thalassaemia major

Answer 50

first yr microcytic anaemia HbA2 and HbF raised HbA absent transfusion, iron chelation therapy may be needed (desferrioxamine)

Question 51

Which type of hodgkins gives the worst and best prognosis

Answer 51

lymphocyte predominant - best depleted - worst

Question 52

Cancer patients with VTE

Answer 52

6 months of DOAC

Question 53

1st line imaging for multiple myeloma

Answer 53

whole body MRI

Question 54

Reversal agent for dabigatran

Answer 54

Idarucizumab